Multicenter Correlation Analysis Of Patient Expectation And Patient-Reported Outcome Measures Of Cataract Surgery: Results From The Raypro Database

To study patient-reported outcome measures (PROMs) following cataract surgery recorded in the RayPRO database (Rayner, Worthing, UK) and to compare these parameters between patients grouped by their expectation of cataract surgery. This study aims to assess satisfaction, spectacle independence, and visual quality PROMs with different intraocular lens (IOL) types incl. monofocal, enhanced monofocal, extended depth of focus (EDOF), multifocal (MF), grouped by patient expectation.

Multicenter survey enrolling 183 centers in 22 countries.

Using anonymous email questionnaires, the RayPRO platform collected PROMs, namely, satisfaction with outcome; spectacle independence (SI) at distance, intermediate, and near, and day and night dysphotopsia. Each PROM was scored from 0 to 10. Analysis was stratified by IOL types and most recorded models: Monofocal – Acrysof IQ (Alcon Inc., USA), RayOne Aspheric/Spheric/Toric (Rayner, UK), Tecnis Eyhance (Johnson & Johnson Vision, USA); EDOF – Acrysof IQ Vivity, Enhanced monofocal - RayOne EMV/ EMV Toric; MF RayOne Galaxy & Trifocal at 3 months post-op. Subgroup analysis was done by patients’ response to whether the visual outcomes as discussed and agreed with the surgeon were achieved after cataract surgery (Yes/ No/ Not Sure).

5697 patients and 95 IOL models were enrolled. Satisfaction scores were highest in the “Yes” group and lowest in the “No” group. Mean SI scores (distance/intermediate/near) were higher in “Yes” group (ranging from 6.4±4.0/5.6±3.7 [RayOne Aspheric]/ 3.6±3.7 [Acrysof IQ] to 9.5±2.0/9.5±2.0/9.5±1.9 [RayOne Trifocal]) than in “No” group (range: 5.0±4.1/4.3±4.1 [RayOne Aspheric]/3.0±3.8 [Acrysof IQ] to 7.9±4.0/10.0±0/10.0±0 [RayOne Galaxy]). Mean dysphotopsia (day/night) was higher in “No” group (range: 4.0±4.0 [Acrysof IQ] /3.2±4.0 [RayOne Toric] to 7.7±1.8/7.6±2.6 [RayOne Trifocal]) than in “Yes” group (range: 1.8±2.1 [RayOne Trifocal]/ 1.9±2.4 [RayOne Toric] to 2.8±2.2 [RayOne Aspheric]/3.0±2.5 [RayOne Trifocal]).

Patients who achieved their expected visual outcomes after cataract surgery had higher satisfaction, higher SI, and lower dysphotopsia. Conversely, patients who did not achieve expected visual outcomes had lower satisfaction, lower spectacle independence, and higher dysphotopsia. In the latter group, monofocal IOLs were generally more forgiving of visual disturbances than MF and EDOF IOLs, with the exception of the RayOne Galaxy IOL, which had dysphotopsia scores comparable to monofocal IOLs, suggesting a favorable dysphotopsia profile in patients unhappy with cataract surgery. Our findings highlight the importance of aligning the achievable spectacle-independent vision and quality of vision with patients’ expectations before surgery.